Diagnosis, treatment and surgery.

This patient was told by 3 doctors that they should remove her uterus, but thanks to her MRI and a virtual consultation, Dr. Valdés was able to explain each of the fibroids and the plan to perform the surgery to remove them.

Today the patient is back in Colombia, with her fertility intact.

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About this case of Uterine fibroids

Ok, we wanted to show you now with this, as we had mentioned, imaging, tomography and MRI. We just had surgery on this little patient, she is from Colombia, but to give you an idea, she is 39 years old, almost 40, and she just came, I interviewed her on October 3 via zoom and she came for surgery just last week, that is , only 23 days passed in preparing the document issues, but I wanted to show you the images that she sent me in her first interview and with that we were able to give her a precise diagnosis and also tell her what the surgical intervention was going to be like and see the risk especially of bleeding.

So I wanted to show you why the images that they handle in the health sector are very interesting, look, this is a sagittal tomography, we see all the tumor that is anterior, these are two more tumors, here begins what would be the cervix more or less, but it I’m going to move so you can see that, father, the imaging, this is the bladder, the fibroid is still visible, 2 fibroids here on the back side and if I start to move it up, you can see how the pedunculated can be seen completely. Why do we know that this one is pedunculated? ? Because when we begin to see the uterine body it never comes into contact with the muscles and here another myomite appears that is also a pedunculate and this is completely the free cavity of the uterine muscle but the uterine edge is well rounded and well delimited.

So this is the fibroid with large elements, this tumor was approximately 20 centimeters long but it was without involvement of the uterine muscles. Here we see a myomite that she also had during surgery and two more that were on the posterior surface, which are these two images But the importance of having a good MRI or a good CT scan is that we, the patient, can give the patient guidance on remembering the characteristics of fibroids. This is a pure subserous fibroid, which in fact during surgery you will notice it has a pedicle or had a pedicle more or less 3 or 4 centimeters in diameter, too large and as soon as we started the surgery there was a bleeding of 200 milliliters , in which we managed to clamp that pedicle but subserosal fibroids are generally very easy to resect or dissect, the main problem is the vascular pedicle.

So right now this patient is going to do us the favor of having an interview with us so that she can tell us a little about how she found us on YouTube, how she made the contact, how she made the whole relationship to come and how important or how easy it was. Sometimes it turns out to be encouraged to come with us. They had obviously told her that this surgery was going to remove her entire uterus, they had even already sent her to medical oncology, that is, to an oncological surgeon of those who deal with tumors or cancers, because they told her that this had to be done. do everything in the routine of removing the uterus, removing the uterus and fibroids and look at the fibroid, it reached exactly below, this is the umbilical scar, exactly below the umbilical scar but it was a fibroid that was too irregular, they are going to do it Let’s see in surgery. But if I wanted to tell you that all the patients who are foreign, the tomography or the MRI for us is a fundamental weapon because it will give us a very real idea of how the situation is, the ultrasounds are important because we have to remember the ultrasound is like the primary diagnosis that the obstetrician-gynecologist has to be able to do a gynecological evaluation of the patient and say “Hey, you know, I think you have a fibroid, it’s large” but in many cases the ultrasound window is very small and does not give us all the real dimension of a tumor and much less, sometimes, it gives us the differentiation between intramural, subserous, submucosal and generally see the dimensions, so if a tomography is very important, see how the cavity looks free. This patient is leaving on Monday, now we are going to interview her, but the advantage of this woman is that since we do not touch almost the uterine muscles, she can get pregnant in two or three months maximum and it is important to know that with age we are very imprisoned with fertility, then we must guide her on the next step of seeking pregnancy, remember “Knowledge is power” call us, write to us, we have a virtual consultation and we can assist you.

Myomectomy or surgery for large element fibroids

We now have this patient, she has a completely subserous right horn myoma, here we see the structure of the tube, this is the round ligament, the uterus is here, but the pedicle has already started to bleed, which has a very large pedicle, so let’s go to go quickly to puncture that pedicle.

Just at the beginning, the stem, the pedicle, began to tear, that stem was very fragile and began to bleed and in a matter of 3 – 5 minutes it only bled 200 milliliters, so you can see the importance or vascularity of that large tumor and then what we had to do is that we put the hemostatic clamps so that we would not continue bleeding and we had to first remove the previous fibroid, which was another pedicle fibroid, because it was hindering us from being able to clamp those pedicles very well and to be able to do the surgery. , so we ended up first removing the 4-centimeter myomite that was also subserous anteriorly and then we had to morcellate this fibroid in sections because the incision had been very small and we did a resection of more or less 5 or 6 tumors of the same tumor and then we were able to externalize what was left of that pedicle, now if we clamped the pedicles very well and gave stitches, then you will see it in the surgery, it is a surgery that did not take more than two hours, it was an hour and a half or so, but Yes, it is true that in this type of tumor, what needs to be most careful and delicate is the vascular pedicle.

So, not all surgeries are so simple or so complicated, the most important thing here is to have the certainty or the speed to be able to do prompt hemostasis and then work on the other fibroids. There is nothing more to know: See the importance of the pedicle, in addition to everything we morcellated was a tumor of about 18 centimeters but look at the pedicle, actually this surgery, although relatively easy, began to get a little complicated because in the anterior part it was torn the tissue because of the large pedicle it had, so we had to click from the beginning and morcellate it quickly to try to remove it as quickly as possible, as I have always said, subserosal fibroids are relatively simple, but the danger is bleeding from their pedicles In this case, just before starting the surgery, he bled 200 milliliters, but now the hemostasis is completely done.

I always tell them, the subserous are the simplest but the main risk is bleeding and seeing that the pedicle is well clamped. In intramural fibroids, those that are in the uterine muscle, they are sometimes safer or easier, however, I always prefer to operate on the subserosal ones because sometimes you can make a relatively small incision and obviously it takes longer because you have to model it. .

This is another posterior fibroid, this is the uterine fundus and there is another one in the posterior isthmic region, almost at the level of the uterosacrals, her left tube, her ovary, and round ligament. We are going to remove as many as we can but it is a slightly laborious surgery, although the largest one has already emerged.

“Please write to us, we can guide you and we will be happy to help you.”

Dr. Arturo Valdés
Dr. Arturo Valdés
Reproductive Medicine and Gynecological Endocrinology
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